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What does the ENT examination report indicate?

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Posted on Fri, 22 May 2015
Question: 40 years old female member presented in the hospital with the complaints of bilateral hearing loss. She is having this problem for the last 4 years. There is no history of vertigo, tinnitus. There is no history of trauma or fever. Medical management was done but limited relief. There is history of Myringotomy in right ear 3 years back

ENT examination was done which showed

Ears:
Right ear: healed perforation in operated ear
Left ear: Normal

Tuning fork test:
reveal bilateral conductive deafness, left more than right

Nose:
Normal
Throat
Normal

Ear Microscopy:
Right ear: healed tympanic membrane
Left ear: Normal

Pure tone Audiometry:
Showed right ear severe mixed deafness and left ear showed moderate mixed deafness

Impedence test:
Bilateral A type with absent reflexes

Diagnosis:

Bilateral Otosclerosis


Please advise if Left ear exploratory tympanotomy/Stapedectomy is recommended in this case or Right ear Stapedectomy is recommended as per clinical guidelines and as per our clinical experience.
doctor
Answered by Dr. Krunal Karade (1 hour later)
Brief Answer:
The ear with poorer hearing, based on the patient’s report should operated

Detailed Answer:
Hi XXXXXXX ,
Thanks for the query.

I have read your query , review your report and understand your concern.

The ear with poorer hearing, based on the patient’s report rather than audiography, should undergo the operation first. In this case , left ear .

Left ear exploratory tympanotomy/Stapedectomy is recommended in this case as per clinical guidelines and as per our clinical experience.

In bilateral cases, the second ear can be operated on 6 months later, assuming this is now the poorer-hearing ear.

Hope this information helpful to you .If you have any further questions I will be happy to help.

Regards.


Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Krunal Karade (1 hour later)
Dear Dr Krunal,

Thank you for your brief answer. As you mentioned in your answer, the recommendation of surgery is based on patient's report rather than Audiography. as per tunning fork test, there is bilateral conductive deafness more on the left side. However, she is now complaining of more hearing loss in right ear not in left ear.
Should we need to go for another Audiography to check the ears or immediately decide to do Right Stapedectomy as per member's complaints.
As i know Stapedectomy is effective if there is conductive hearing loss, but in this case there is mixed hearing loss (severe in right ear and moderate in left ear). In my opinion in this case, Stapedectomy will be helpful in left ear and try to use hearing aid in right ear.
Initially treating Surgeon in this case was requesting for left ear stapedectomy but later on, he changed the decision and decided to do on the right side as she is complaining of more deafness in the right ear.
doctor
Answered by Dr. Krunal Karade (1 hour later)
Brief Answer:
let your treating Surgeon decides the side of ear he want to operate .

Detailed Answer:
Hi XXXXXXX ,
Thanks for the follow up query.

As per clinical guidelines , the ear with poorer hearing, based on the patient’s report , should undergo the operation first.

If patient is complaining of more hearing loss in right ear then it should operated first .

If Audiography report are not latest then do latest Pure tone Audiometry & Impedence test with reflexes . Also do latest all tuning fork test .

Yes , Stapedectomy is more effective in ear with more conductive hearing loss.

Stapedectomy success rate is around 95 % . If surgeon is more confident about his results then he can do Stapedectomy in better ear & give nearly normal hearing level in better ear .

But if Stapedectomy fail in better ear then patient will become deaf & has to use hearing aid in other ear . Revision Stapedectomy result is around 50%-70% .

If I were your treating Doctor for this case , I would advice you
let your treating Surgeon decides the side of ear he want to operate . He knows his result better .

Hope this information helpful to you .
Regards.


Above answer was peer-reviewed by : Dr. Pradeep Vitta
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Answered by
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Dr. Krunal Karade

ENT Specialist

Practicing since :2009

Answered : 1000 Questions

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What does the ENT examination report indicate?

Brief Answer: The ear with poorer hearing, based on the patient’s report should operated Detailed Answer: Hi XXXXXXX , Thanks for the query. I have read your query , review your report and understand your concern. The ear with poorer hearing, based on the patient’s report rather than audiography, should undergo the operation first. In this case , left ear . Left ear exploratory tympanotomy/Stapedectomy is recommended in this case as per clinical guidelines and as per our clinical experience. In bilateral cases, the second ear can be operated on 6 months later, assuming this is now the poorer-hearing ear. Hope this information helpful to you .If you have any further questions I will be happy to help. Regards.